华法林基因组检测指导瓣膜置换术后抗凝治疗的临床研究

发布时间：2019-01-23 19:31

【摘要】：[目的]研究华法林药物基因组检测在心脏瓣膜置换术后抗凝治疗中的指导作用。[方法]按照标准选取昆明医科大学第二附属医院心脏血管外科2015年7月至2016年12月首次行心脏瓣膜手术患者62例,并将其分为试验组(行华法林药物基因组检测,并根据检测报告中的建议预计剂量给予初始剂量)和对照组(未行华法林药物基因组检测,均给予3mg/d的华法林剂量),所有患者术后拔除气管插管24小时内均给予口服华法林钠抗凝治疗,并依据国际标准化比值(INR)监测结果对华法林进行调整,以INR值达到目标范围,且华法林剂量稳定为准。比较试验组和对照组在华法林抗凝治疗3、5、7d及出院达标率等方面的差异、华法林达标时间、稳定剂量、试验组中华法林预测剂量与稳定剂量间的差异。[结果]试验组患者CYP2C9*2基因以CC为主(100%),CYP2C9*3基因以AA型为主(97.22%),AC (2.78%) ; VKORC1 基因以 M 为主(88.9%),GG (0%),GA (1.11%);试验组华法林稳定剂量与预测剂量之间具有相关性(r=0.952,P0. 001);试验组华法林在用药3d,5d,7d及出院前抗凝指标达标率均有统计学意义(P0. 05);试验组与对照组在华法林稳定剂量及两组患者住院期间出现不良反应的发生率均无统计学意义(P0. 05)。[结论]华法林基因组检测在临床中指导华法林抗凝治疗,具有参考价值,可减少临床医师在华法林抗凝治疗中的盲目性,尤其是在初始剂量的确定上,但也存在局限性,有待进一步更大规模、更完善、更深入、更符合中国人群的临床研究。
[Abstract]:Objective: to study the guiding role of warfarin in anticoagulant therapy after valvular replacement. [methods] Sixty-two patients undergoing cardiac valvular surgery in the second affiliated Hospital of Kunming Medical University from July 2015 to December 2016 were selected and divided into two groups. The initial dose of warfarin and the control group (warfarin dose of 3mg/d were given without warfarin drug genome test), and the initial dose was given according to the recommended dose of warfarin in the test report. All patients were given oral warfarin sodium anticoagulant therapy within 24 hours after tracheal intubation, and warfarin was adjusted according to the results of international standardized ratio (INR) monitoring. The INR value reached the target range, and the warfarin dose was stable. The differences of warfarin anticoagulant therapy and discharge rate were compared between the test group and the control group. The time of warfarin reaching the standard and the stable dose were compared. The difference between the predicted dose and the stable dose of warfarin in the test group was compared. [results] in the test group, CC was the main gene of CYP2C9*2 (100%), AA was the predominant gene of CYP2C9*3 (97.22%), AC (2.78%), VKORC1 gene was M (88.9%), GG (0%), GA (1.11%). There was a correlation between the amount of warfarin stabilizer and the predicted dose in the test group (r = 0.952, P 0. In the test group, warfarin had significant difference in 3 days, 5 days, 7 days and before discharge (P 0. 01), and the anticoagulant index reached the standard rate before discharge (P 0. 01). There was no significant difference in the dosage of warfarin stabilizer and the incidence of adverse reactions during hospitalization between the two groups (P0. ) [conclusion] warfarin genome detection has reference value in guiding warfarin anticoagulant therapy in clinic, and can reduce the blindness of clinicians in warfarin anticoagulant therapy, especially in the determination of initial dosage, but it also has some limitations. Need to be further larger, more perfect, more in-depth, more in line with the Chinese population of clinical research.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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